Provider Demographics
NPI:1609512375
Name:OLUKOYA, ADEOLA
Entity type:Individual
Prefix:
First Name:ADEOLA
Middle Name:
Last Name:OLUKOYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 ROLAND MANOR DR
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-6582
Mailing Address - Country:US
Mailing Address - Phone:762-217-7503
Mailing Address - Fax:
Practice Address - Street 1:415 ROLAND MANOR DR
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-6582
Practice Address - Country:US
Practice Address - Phone:762-217-7503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant